Provider Demographics
NPI:1487681490
Name:KISHIDA, GARY TADASHI (MD)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:TADASHI
Last Name:KISHIDA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:88 PIIKOI ST.
Mailing Address - Street 2:APT. 3905
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96814-4285
Mailing Address - Country:US
Mailing Address - Phone:808-596-2445
Mailing Address - Fax:
Practice Address - Street 1:88 PIIKOI ST.
Practice Address - Street 2:APT. 3905
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96814-4285
Practice Address - Country:US
Practice Address - Phone:808-596-2445
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD4192682085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G236710Medicaid
CA00G236710Medicaid
A42032Medicare UPIN